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von Haehling S, Assmus B, Bekfani T, Dworatzek E, Edelmann F, Hashemi D, Hellenkamp K, Kempf T, Raake P, Schütt KA, Wachter R, Schulze PC, Hasenfuss G, Böhm M, Bauersachs J. Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment. Clin Res Cardiol 2024:10.1007/s00392-024-02396-4. [PMID: 38602566 DOI: 10.1007/s00392-024-02396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/12/2024]
Abstract
The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Birgit Assmus
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Giessen, Germany
| | - Tarek Bekfani
- Department of Cardiology and Angiology, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Elke Dworatzek
- Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Edelmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Djawid Hashemi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Berlin, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Raake
- I. Medical Department, Cardiology, Pneumology, Endocrinology and Intensive Care Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Katharina A Schütt
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Münks J, Yogeswaran A, Antoine TK, Blumrich LA, Dorfmüller P, Ghofrani HA, Assmus B, Schermuly RT, Sydykov A. A Novel Rat Model of Mild Pulmonary Hypertension Associated with Pulmonary Venous Congestion Induced by Left Pulmonary Vein Banding. Int J Mol Sci 2024; 25:2827. [PMID: 38474074 DOI: 10.3390/ijms25052827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common form of PH. In PH-LHD, changes in the pulmonary vasculature are assumed to be mainly caused by pulmonary venous congestion. However, the underlying mechanisms of this form of PH are poorly understood. We aimed to establish a model of PH associated with pulmonary venous congestion. Wistar-Kyoto rats underwent partial occlusion of the left pulmonary vein to induce pulmonary venous congestion or sham surgery and were assessed at various time points post-surgery (3, 6, 9, 12 weeks). In vivo cardiopulmonary phenotyping was performed by using echocardiography along with heart catheterization. Histomorphometry methods were used to assess pulmonary vascular remodeling (e.g., wall thickness, degree of muscularization). Left pulmonary vein banding (PVB) resulted in mildly elevated right ventricular systolic pressure and moderate right ventricular hypertrophy. In PVB rats, small- and medium-sized pulmonary vessels in the left lung were characterized by increased wall thickness and muscularization. Taken together, our data demonstrate that left PVB-induced pulmonary venous congestion is associated with pulmonary vascular remodeling and mild PH.
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Affiliation(s)
- Jonas Münks
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Athiththan Yogeswaran
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Tobiah Kevin Antoine
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Leonhard Anton Blumrich
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Peter Dorfmüller
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
- Department of Pathology, Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Birgit Assmus
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
- Department of Cardiology and Angiology, Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Ralph Theo Schermuly
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
| | - Akylbek Sydykov
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus Liebig University of Giessen, 35392 Giessen, Germany
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Husain‐Syed F, Singam NSV, Viehman JK, Vaughan L, Bauer P, Gall H, Tello K, Richter MJ, Yogeswaran A, Romero‐González G, Rosner MH, Ronco C, Assmus B, Ghofrani HA, Seeger W, Birk H, Kashani KB. Changes in Doppler-Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure. J Am Heart Assoc 2023; 12:e030145. [PMID: 37577933 PMCID: PMC10492931 DOI: 10.1161/jaha.123.030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Background The impact of changes in Doppler-derived kidney venous flow in heart failure (HF) is not well studied. We aimed to investigate the association of Doppler-derived kidney venous stasis index (KVSI) and intrakidney venous-flow (IKVF) patterns with adverse cardiorenal outcomes in patients with HF. Methods and Results In this observational cohort study, consecutive inpatients with HF referred to a nephrologist because of a history of diuretic resistance and abnormal kidney function (n=216) underwent spectral kidney assessments after admission (Doppler 1) and 25 to 35 days later (Doppler 2) to identify IKVF patterns (continuous/pulsatile/biphasic/monophasic) and KVSI levels. Cox proportional hazard regression models were used to evaluate the associations between KVSI/IKVF patterns at Doppler 1 as well as changes from Doppler 1 to Doppler 2 and risk of cardiorenal events up to 18 months after admission. Worsening HF or death occurred in 126 patients. Both baseline KVSI (hazard ratio [HR], 1.49 [95% CI, 1.37-1.61] per 0.1-unit increase) and baseline IKVF pattern (HR, 2.47 [95% CI, 2.01-3.04] per 1 pattern severity increase) were significantly associated with worsening HF/death. Increases in both KVSI and IKVF pattern severity from Doppler 1 to 2 were also associated with an increased risk of worsening HF/death (HR, 3.00 [95% CI, 2.08-4.32] per 0.1-unit increase change; and HR, 6.73 [95% CI, 3.27-13.86] per 1 pattern increase in severity change, respectively). Similar results were observed for kidney outcomes. Conclusions Baseline kidney venous flow predicted adverse cardiorenal events, and inclusion of serial kidney venous flow in cardiorenal risk stratification could facilitate clinical decision-making for patients with HF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03039959.
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Affiliation(s)
- Faeq Husain‐Syed
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Narayana Sarma V. Singam
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineMayo ClinicRochesterMN
- Departments of Cardiology and Critical CareMedStar Washington Hospital CenterWashingtonDCUSA
| | - Jason K. Viehman
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Lisa Vaughan
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Pascal Bauer
- Division of Cardiology and Angiology, Department of Internal Medicine IUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Henning Gall
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Khodr Tello
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Manuel J. Richter
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Athiththan Yogeswaran
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Gregorio Romero‐González
- Department of NephrologyUniversity Hospital Germans Trias i PujolBarcelonaSpain
- International Renal Research Institute of Vicenza, Department of NephrologyDialysis and Transplantation, San Bortolo HospitalVicenzaItaly
| | - Mitchell H. Rosner
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of NephrologyDialysis and Transplantation, San Bortolo HospitalVicenzaItaly
- Department of MedicineUniversità di PadovaPaduaItaly
| | - Birgit Assmus
- Division of Cardiology and Angiology, Department of Internal Medicine IUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of PulmonologyKerckhoff‐KlinikBad NauheimGermany
| | - Werner Seeger
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Horst‐Walter Birk
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineMayo ClinicRochesterMN
- Division of Nephrology and Hypertension, Department of Internal MedicineMayo ClinicRochesterMNUSA
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Assmus B, Angermann CE, Alkhlout B, Asselbergs FW, Schnupp S, Brugts JJ, Nordbeck P, Zhou Q, Brett ME, Ginn G, Adamson PB, Böhm M, Rosenkranz S. Effects of remote haemodynamic-guided heart failure management in patients with different subtypes of pulmonary hypertension: insights from the MEMS-HF study. Eur J Heart Fail 2022; 24:2320-2330. [PMID: 36054647 DOI: 10.1002/ejhf.2656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 07/17/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023] Open
Abstract
AIM The CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF) investigated safety and efficacy of pulmonary artery pressure (PAP)-guided remote patient management (RPM) in New York Heart Association (NYHA) class III outpatients with at least one heart failure hospitalization (HFH) during the previous 12 months. This pre-specified subgroup analysis investigated whether RPM effects depended on presence and subtype of pulmonary hypertension (PH). METHODS AND RESULTS In 106/234 MEMS-HF participants, Swan-Ganz catheter tracings obtained during sensor implant were available for off-line manual analysis jointly performed by two experts. Patients were classified into subgroups according to current PH definitions. Isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH) were present in 38 and 36 patients, respectively, whereas 31 patients had no PH. Clinical characteristics were comparable between subgroups, but among patients with PH pulmonary vascular resistance was higher (p = 0.029) and pulmonary artery compliance lower (p = 0.003) in patients with CpcPH. During 12 months of PAP-guided RPM, all PAPs declined in IpcPH and CpcPH subgroups (all p < 0.05), whereas only mean and diastolic PAP decreased in patients without PH (both p < 0.05). Improvements in post- versus pre-implant HFH rates were similar in CpcPH (0.639 events/patient-year; hazard ratio [HR] 0.37) and IpcPH (0.72 events/patient-year; HR 0.45) patients. Participants without PH benefited most (0.26 events/patient-year; HR 0.17, p = 0.04 vs. IpcPH/CpcPH patients). Quality of life and NYHA class improved significantly in all subgroups. CONCLUSIONS Outpatients with NYHA class III symptoms with at least one HFH during 1 year pre-implant benefitted significantly from PAP-guided RPM during post-implant follow-up irrespective of presence or subtype of PH at baseline.
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Affiliation(s)
- Birgit Assmus
- Cardiology, Department of Medicine, Goethe University Hospital, Frankfurt, Germany.,Medical Clinic I, Department of Cardiology, University Hospital Giessen, Justus Liebig University Giessen, Giessen, Germany
| | | | - Basil Alkhlout
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg-Western Pommerania, Karlsburg, Germany
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Steffen Schnupp
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology, Coburg, Germany
| | - Jasper J Brugts
- Thorax Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.,Cardiology, Department of Medicine I, Centre for Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University of Freiburg, Bad Krozingen, Germany
| | | | | | | | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine, and Cologne Cardiovascular Research Center (CCRC), University of Cologne Heart Center, Köln, Germany
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Baumeier C, Aleshcheva G, Harms D, Gross U, Hamm C, Assmus B, Westenfeld R, Kelm M, Rammos S, Wenzel P, Münzel T, Elsässer A, Gailani M, Perings C, Bourakkadi A, Flesch M, Kempf T, Bauersachs J, Escher F, Schultheiss HP. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. Int J Mol Sci 2022; 23:ijms23136940. [PMID: 35805941 PMCID: PMC9266869 DOI: 10.3390/ijms23136940] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty® (Pfizer-BioNTech) (n = 11), Vaxzevria® (AstraZenica) (n = 2) and Janssen® (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 10). Importantly, infectious causes have been excluded in all patients. The SARS-CoV-2 spike protein has been detected sparsely on cardiomyocytes of nine patients, and differential analysis of inflammatory markers such as CD4+ and CD8+ T cells suggests that the inflammatory response triggered by the vaccine may be of autoimmunological origin. Although a definitive causal relationship between COVID-19 vaccination and the occurrence of myocardial inflammation cannot be demonstrated in this study, data suggest a temporal connection. The expression of SARS-CoV-2 spike protein within the heart and the dominance of CD4+ lymphocytic infiltrates indicate an autoimmunological response to the vaccination.
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Affiliation(s)
- Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
- Correspondence: ; Tel.: +49-30-8441-5543
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Dominik Harms
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Ulrich Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Christian Hamm
- Kerckhoff Heart Center, Department of Cardiology, 61231 Bad Nauheim, Germany;
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Gießen, Germany;
| | - Birgit Assmus
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Gießen, Germany;
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (M.K.)
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (M.K.)
| | - Spyros Rammos
- Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany; (P.W.); (T.M.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany; (P.W.); (T.M.)
| | - Albrecht Elsässer
- Department of Cardiology, Klinikum Oldenburg, 26133 Oldenburg, Germany;
| | | | - Christian Perings
- Department of Cardiology, St. Marien-Hospital, 44534 Lünen, Germany;
| | - Alae Bourakkadi
- Department of Internal Medicine, Cardiology, Geriatrics and Palliative Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, 56727 Mayen, Germany;
| | - Markus Flesch
- Department of Cardiology, Marienkrankenhaus gGmbH, 59494 Soest, Germany;
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany; (T.K.); (J.B.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany; (T.K.); (J.B.)
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
- Department of Cardiology, Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
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6
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Sharif F, Rosenkranz S, Bartunek J, Kempf T, Assmus B, Mahon NG, Mullens W. Safety and efficacy of a wireless pulmonary artery pressure sensor: primary endpoint results of the SIRONA 2 clinical trial. ESC Heart Fail 2022; 9:2862-2872. [PMID: 35686479 DOI: 10.1002/ehf2.14006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Implantable pulmonary artery pressure (PAP) sensors have been shown to reduce heart failure hospitalizations (HFH) in selected patients. The goal of this study was to evaluate the safety and efficacy of a novel wireless PAP monitoring system in patients with heart failure (HF). METHODS AND RESULTS This is a prospective, multi-centre, open-label, single-arm trial evaluating the safety and efficacy of the Cordella™ PA Sensor System including the comprehensive Cordella™ Heart Failure System (CHFS) in patients with New York Heart Association (NYHA) Class III heart failure with a heart failure hospitalization and/or increase of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) within 12 months of enrolment. The primary efficacy endpoint was the accuracy of PA sensor mean PAP measurements, compared with fluid-filled catheter mean PAP measurements obtained by standard right heart catheterization (RHC) at 90 days post-implant, assessed in all patients with a successful implant. The primary safety endpoint was freedom from adverse events associated with use of the Cordella PA Sensor System through 30 days post-implant, assessed in all patients who entered the cath lab for PA sensor implant. The PA sensor was successfully implanted in 70 patients. Equivalence between the PA sensor and RHC for mean pulmonary artery pressures was excellent with measurements confined within the equivalence bounds of -4.0 to 4.0 mmHg (mean PAP: 0.0 to 2.9 mmHg, P = 0.003). The device safety profile was excellent with 98.6% freedom from Device System Related Complications, defined as invasive treatment, device explant or death. There were no pressure sensor failures. Patients' adherence to daily measurement transmissions of PAP and vital signs was 94%. CONCLUSIONS This trial supports the safety and efficacy of the Cordella PA Sensor System and in conjunction with the CHFS enables comprehensive HF management in NYHA class III heart failure patients.
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Affiliation(s)
- Faisal Sharif
- Department of Cardiology, Galway University Hospital, Saolta Group, CURAM and BioInnovate Ireland, National University of Ireland Galway, Galway, Ireland
| | - Stephen Rosenkranz
- Clinic III for Internal Medicine, University of Cologne Heart Center and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Ziekenhuis Aalst, Aalst, Belgium
| | - Tibor Kempf
- Department of Cardiology and Angiology, Centre for Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Birgit Assmus
- Department of Cardiology and Angiology, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Niall G Mahon
- Department of Cardiovascular Medicine, Mater University Hospital and University College Dublin, Dublin, Ireland
| | - Wilfried Mullens
- Department of Cardiovascular Medicine, Ziekenhuis Oost Limburg, University Hasselt, Genk, Belgium
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Herrmann EJ, Raghavan B, Eissing N, Fichtlscherer S, Hamm CW, Assmus B. Pulmonary Artery Pressure-Guided Telemonitoring Reduced Pulmonary Artery Pressure but Did Not Result in Higher Doses of Guideline-Directed Medical Therapy-Observations from an Advanced Elderly German Heart Failure Cohort. Life (Basel) 2022; 12:life12050766. [PMID: 35629432 PMCID: PMC9147310 DOI: 10.3390/life12050766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Remote pulmonary artery pressure (PAP)-guided heart failure (HF) therapy for NYHA class III patients has been shown to reduce hospitalizations and increase survival. We aimed to assess whether PAP monitoring allows for the increase in HF directed medication in an elderly German cohort of advanced HF patients already receiving clinically optimized HF medication. Methods: We analyzed PAP and HF medication dosage, including diuretics, in 24 patients (mean age, 76 years) using implanted PAP-sensors during the first 12 months of PAP-guided HF care in an interdisciplinary HF unit. Results: During 12 months of PAP-guided HF therapy, PAP decreased significantly (△PAP systolic−6 ± 10, △PAP diastolic−4 ± 7, △PAP mean−4 ± 8 mm Hg, p < 0.01 for all). 16% of patients had an unplanned HF hospitalization. There was no significant change over time with respect to the dosage of RAAS inhibitors (ACE-I/ARB/ARNI), Beta blockers, or MRA treatments. In contrast, the dosage of loop diuretics increased significantly (2.1 ± 0.5-fold) over time. In the comparison of a “responder” (patients with PAP and diuretic dose decline) and “non-responder” (patients with PAP and diuretic dose increase) group, there were no significant differences between any of the baseline, medication, or HF hospitalization characteristics between the two groups. Conclusions: In elderly patients treated with clinically optimized HF medication, no further evidence-based medication increase could be achieved using PAP-guided HF care. However, by individual adjustment of diuretic dosage, a significant decline in PAP over time occurred, which could not be predicted by any of the baseline characteristics.
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Affiliation(s)
- Ester J. Herrmann
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
| | - Badrinarayanan Raghavan
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
| | - Nina Eissing
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
| | - Stephan Fichtlscherer
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
| | - Christian W. Hamm
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
| | - Birgit Assmus
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
- Correspondence:
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8
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Bulinski C, Discher T, Rutsatz W, Assmus B, Krämer HH. Clinical improvement after change of therapy from tafamidis to patisiran in progressive TTR amyloidosis post-liver transplantation. J Neurol 2022; 269:3912-3914. [PMID: 35124750 PMCID: PMC9217831 DOI: 10.1007/s00415-022-10978-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine Bulinski
- Department of Internal Medicine, Infeciology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Thomas Discher
- Department of Internal Medicine, Infeciology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Wiebke Rutsatz
- Department of Cardiology, Justus Liebig University, Giessen, Germany
| | - Birgit Assmus
- Department of Cardiology, Justus Liebig University, Giessen, Germany
| | - Heidrun H Krämer
- Department of Neurology, Justus Liebig University, Giessen, Germany
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9
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Skrahina V, Grittner U, Beetz C, Skripuletz T, Juenemann M, Krämer HH, Hahn K, Rieth A, Schaechinger V, Patten M, Tanislav C, Achenbach S, Assmus B, Knebel F, Gingele S, Skrahin A, Hartkamp J, Förster TM, Roesner S, Pereira C, Rolfs A. Hereditary transthyretin-related amyloidosis is frequent in polyneuropathy and cardiomyopathy of no obvious aetiology. Ann Med 2021; 53:1787-1796. [PMID: 34658264 PMCID: PMC8525987 DOI: 10.1080/07853890.2021.1988696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Hereditary Transthyretin-Related Amyloidosis, a clinically heterogeneous autosomal dominant disease caused by pathogenic variants in the TTR gene, is characterized by the deposition of insoluble misfolded protein fibrils. The diagnosis, especially in non-endemic areas, is typically delayed by 4-5 years; a misdiagnosis due to clinical heterogeneity is common. The study objective was to define the prevalence of Hereditary Transthyretin-Related Amyloidosis in patients with polyneuropathy and/or cardiomyopathy of no obvious aetiology. METHOD A multicenter observational "Epidemiological analysis for the hereditary Transthyretin-Related AMyloidosis"-TRAM study was performed in Germany, Austria, and Switzerland. RESULTS A total of 5141 participants were recruited by 50 neurologic and 27 cardiologic specialized centres. Genetic analysis demonstrated a 1.1% Hereditary Transthyretin-Related Amyloidosis positivity rate among patients with polyneuropathy and/or cardiomyopathy of not obvious aetiology. Twenty-one various TTR variants (TTR-positive) were identified. Body Mass Index was lower in the TTR-positive patients as an indicator for the involvement of the autonomic nervous system; the age of onset of clinical manifestations was higher in TTR-positive patients. There were no other genotype-phenotype correlations or the prevalence of specific clinical manifestations in TTR-positive patients. CONCLUSIONS Our data support the fact that Hereditary Transthyretin-Related Amyloidosis is underdiagnosed in polyneuropathy and cardiomyopathy patients. Routine implementation of genetic testing is recommended in patients with unexplained polyneuropathy and/or cardiomyopathy to accelerate the earlier diagnosis and the time-sensitive treatment initiation.KEY MESSAGESMore than 5.000 participants with CM and/or PNP of no obvious aetiology were recruited in the observational "Epidemiological analysis for the hereditary Transthyretin-Related AMyloidosis" TRAM study and screened for pathogenic TTR variants.The study demonstrated >1% of patients with CM and/or PNP of unclear aetiology are positive for a pathogenic TTR variant.Routine genetic testing is recommended in patients with unexplained CM and/or PNP to accelerate the initial diagnosis and timely treatment initiation.
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Affiliation(s)
| | - Ulrike Grittner
- CENTOGENE GmbH, Rostock, Germany
- Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | | | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Heidrun H. Krämer
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Katrin Hahn
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Monica Patten
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Christian Tanislav
- Department of Neurology, Evangelisches Jung Stilling Krankenhaus GmbH, Siegen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Erlangen University Hospital, Erlangen, Germany
| | - Birgit Assmus
- Division of Cardiology and Angiology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Fabian Knebel
- Berlin Institute of Health, Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | - Arndt Rolfs
- CENTOGENE GmbH, Rostock, Germany
- University Medicine, University Rostock, Rostock, Germany
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10
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Böhm M, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett ME, Brugts JJ, Ertl G, Wang A, Hilker L, Koehler F, Rosenkranz S, Leistner DM, Abdin A, Wintrich J, Zhou Q, Adamson PB, Angermann CE. Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring. ESC Heart Fail 2021; 9:155-163. [PMID: 34738340 PMCID: PMC8787966 DOI: 10.1002/ehf2.13665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). METHODS AND RESULTS The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m2 ] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m2 , P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21). CONCLUSIONS In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Frankfurt am Main, Germany.,Department of Medicine I, Cardiology/Angiology, University Hospital, Giessen, Germany
| | - Stefan D Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology, Coburg, Germany
| | | | - Jasper J Brugts
- Erasmus MC University Medical Center, Thorax Center, Rotterdam, The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg-Western Pommerania, Karlsburg, Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine, University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC), Köln, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin, Germany
| | - Amr Abdin
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Jan Wintrich
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Bad Krozingen, Germany.,Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Christiane E Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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11
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Johnson V, Birgitta Johnson LS, Napiorkowski NE, Ewa Slusarczyk M, Dziubinski MJ, Assmus B. B-PO05-039 MET SCORE IN PATIENTS WITH AND WITHOUT ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Hoffmann J, Luxán G, Abplanalp WT, Glaser SF, Rasper T, Fischer A, Muhly-Reinholz M, Potente M, Assmus B, John D, Zeiher AM, Dimmeler S. Post-myocardial infarction heart failure dysregulates the bone vascular niche. Nat Commun 2021; 12:3964. [PMID: 34172720 PMCID: PMC8233308 DOI: 10.1038/s41467-021-24045-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
The regulation of bone vasculature by chronic diseases, such as heart failure is unknown. Here, we describe the effects of myocardial infarction and post-infarction heart failure on the bone vascular cell composition. We demonstrate an age-independent loss of type H endothelium in heart failure after myocardial infarction in both mice and humans. Using single-cell RNA sequencing, we delineate the transcriptional heterogeneity of human bone marrow endothelium, showing increased expression of inflammatory genes, including IL1B and MYC, in ischemic heart failure. Endothelial-specific overexpression of MYC was sufficient to induce type H bone endothelial cells, whereas inhibition of NLRP3-dependent IL-1β production partially prevented the post-myocardial infarction loss of type H vasculature in mice. These results provide a rationale for using anti-inflammatory therapies to prevent or reverse the deterioration of bone vascular function in ischemic heart disease.
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Affiliation(s)
- Jedrzej Hoffmann
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Guillermo Luxán
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Wesley Tyler Abplanalp
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Simone-Franziska Glaser
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Tina Rasper
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Ariane Fischer
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Marion Muhly-Reinholz
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Potente
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Birgit Assmus
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
| | - David John
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Michael Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research DZHK, Frankfurt am Main, Germany.
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany.
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany.
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13
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Assmus B, Cremer S, Kirschbaum K, Culmann D, Kiefer K, Dorsheimer L, Rasper T, Abou-El-Ardat K, Herrmann E, Berkowitsch A, Hoffmann J, Seeger F, Mas-Peiro S, Rieger MA, Dimmeler S, Zeiher AM. Clonal haematopoiesis in chronic ischaemic heart failure: prognostic role of clone size for DNMT3A- and TET2-driver gene mutations. Eur Heart J 2021; 42:257-265. [PMID: 33241418 DOI: 10.1093/eurheartj/ehaa845] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/05/2020] [Accepted: 10/09/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Somatic mutations of the epigenetic regulators DNMT3A and TET2 causing clonal expansion of haematopoietic cells (clonal haematopoiesis; CH) were shown to be associated with poor prognosis in chronic ischaemic heart failure (CHF). The aim of our analysis was to define a threshold of variant allele frequency (VAF) for the prognostic significance of CH in CHF. METHODS AND RESULTS We analysed bone marrow and peripheral blood-derived cells from 419 patients with CHF by error-corrected amplicon sequencing. Cut-off VAFs were optimized by maximizing sensitivity plus specificity from a time-dependent receiver operating characteristic (ROC) curve analysis from censored data. 56.2% of patients were carriers of a DNMT3A- (N = 173) or a TET2- (N = 113) mutation with a VAF >0.5%, with 59 patients harbouring mutations in both genes. Survival ROC analyses revealed an optimized cut-off value of 0.73% for TET2- and 1.15% for DNMT3A-CH-driver mutations. Five-year-mortality was 18% in patients without any detected DNMT3A- or TET2 mutation (VAF < 0.5%), 29% with only one DNMT3A- or TET2-CH-driver mutations above the respective cut-off level and 42% in patients harbouring both DNMT3A- and TET2-CH-driver mutations above the respective cut-off levels. In carriers of a DNMT3A mutation with VAF ≥ 1.15%, 5-year mortality was 31%, compared with 18% mortality in those with VAF < 1.15% (P = 0.048). Likewise, in patients with TET2 mutations, 5-year mortality was 32% with VAF ≥ 0.73%, compared with 19% mortality with VAF < 0.73% (P = 0.029). CONCLUSION The present study defines novel threshold levels for clone size caused by acquired somatic mutations in the CH-driver genes DNMT3A and TET2 that are associated with worse outcome in patients with CHF.
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Affiliation(s)
- Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
| | - Sebastian Cremer
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
| | - Klara Kirschbaum
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - David Culmann
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
| | - Katharina Kiefer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Tina Rasper
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
| | - Khalil Abou-El-Ardat
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany.,Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
| | - Alexander Berkowitsch
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Jedrzej Hoffmann
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
| | - Florian Seeger
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Silvia Mas-Peiro
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
| | - Michael A Rieger
- German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute, Georg-Speyer-Haus, Frankfurt, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany.,Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Berlin, Germany, partner site Frankfurt Rhine-Main, Germany
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14
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Kiefer KC, Cremer S, Pardali E, Assmus B, Abou-El-Ardat K, Kirschbaum K, Dorsheimer L, Rasper T, Berkowitsch A, Serve H, Dimmeler S, Zeiher AM, Rieger MA. Full spectrum of clonal haematopoiesis-driver mutations in chronic heart failure and their associations with mortality. ESC Heart Fail 2021; 8:1873-1884. [PMID: 33779075 PMCID: PMC8120376 DOI: 10.1002/ehf2.13297] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/07/2020] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Somatic mutations in haematopoietic stem cells can lead to the clonal expansion of mutated blood cells, known as clonal haematopoiesis (CH). Mutations in the most prevalent driver genes DNMT3A and TET2 with a variant allele frequency (VAF) ≥ 2% have been associated with atherosclerosis and chronic heart failure of ischemic origin (CHF). However, the effects of mutations in other driver genes for CH with low VAF (<2%) on CHF are still unknown. Methods and results Therefore, we analysed mononuclear bone marrow and blood cells from 399 CHF patients by deep error‐corrected targeted sequencing of 56 genes and associated mutations with the long‐term mortality in these patients (3.95 years median follow‐up). We detected 1113 mutations with a VAF ≥ 0.5% in 347 of 399 patients, and only 13% had no detectable CH. Despite a high prevalence of mutations in the most frequently mutated genes DNMT3A (165 patients) and TET2 (107 patients), mutations in CBL, CEBPA, EZH2, GNB1, PHF6, SMC1A, and SRSF2 were associated with increased death compared with the average death rate of all patients. To avoid confounding effects, we excluded patients with DNMT3A‐related, TET2‐related, and other clonal haematopoiesis of indeterminate potential (CHIP)‐related mutations with a VAF ≥ 2% for further analyses. Kaplan–Meier survival analyses revealed a significantly higher mortality in patients with mutations in either of the seven genes (53 patients), combined as the CH‐risk gene set for CHF. Baseline patient characteristics showed no significant differences in any parameter including patient age, confounding diseases, severity of CHF, or blood cell parameters except for a reduced number of platelets in patients with mutations in the risk gene set in comparison with patients without. However, carrying a mutation in any of the risk genes remained significant after multivariate cox regression analysis (hazard ratio, 3.1; 95% confidence interval, 1.8–5.4; P < 0.001), whereas platelet numbers did not. Conclusions Somatic mutations with low VAF in a distinct set of genes, namely, in CBL, CEBPA, EZH2, GNB1, PHF6, SMC1A, and SRSF2, are significantly associated with mortality in CHF, independently of the most prevalent CHIP‐mutations in DNMT3A and TET2. Mutations in these genes are prevalent in young CHF patients and comprise an independent risk factor for the outcome of CHF, potentially providing a novel tool for risk assessment in CHF.
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Affiliation(s)
- Katharina C Kiefer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Sebastian Cremer
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.,Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Frankurt, Germany
| | - Evangelia Pardali
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology, Giessen University Hospital, Giessen, Germany
| | - Khalil Abou-El-Ardat
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Klara Kirschbaum
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Tina Rasper
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
| | | | - Hubert Serve
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Frankurt, Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Frankurt, Germany
| | - Michael A Rieger
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany
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15
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Husain-Syed F, Gröne HJ, Assmus B, Bauer P, Gall H, Seeger W, Ghofrani A, Ronco C, Birk HW. Congestive nephropathy: a neglected entity? Proposal for diagnostic criteria and future perspectives. ESC Heart Fail 2020; 8:183-203. [PMID: 33258308 PMCID: PMC7835563 DOI: 10.1002/ehf2.13118] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/13/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022] Open
Abstract
Venous congestion has emerged as an important cause of renal dysfunction in patients with cardiorenal syndrome. However, only limited progress has been made in differentiating this haemodynamic phenotype of renal dysfunction, because of a significant overlap with pre-existing renal impairment due to long-term hypertension, diabetes, and renovascular disease. We propose congestive nephropathy (CN) as this neglected clinical entity. CN is a potentially reversible subtype of renal dysfunction associated with declining renal venous outflow and progressively increasing renal interstitial pressure. Venous congestion may lead to a vicious cycle of hormonal activation, increased intra-abdominal pressure, excessive renal tubular sodium reabsorption, and volume overload, leading to further right ventricular (RV) stress. Ultimately, renal replacement therapy may be required to relieve diuretic-resistant congestion. Effective decongestion could preserve or improve renal function. Congestive acute kidney injury may not be associated with cellular damage, and complete renal function restoration may be a confirmatory diagnostic criterion. In contrast, a persistently low renal perfusion pressure might induce renal dysfunction and histopathological lesions with time. Thus, urinary markers may differ. CN is mostly seen in biventricular heart failure but may also occur secondary to pulmonary arterial hypertension and elevated intra-abdominal pressure. An increase in central venous pressure to >6 mmHg is associated with a steep decrease in glomerular filtration rate. However, the central venous pressure range that can provide an optimal balance of RV and renal function remains to be determined. We propose criteria to identify cardiorenal syndrome subgroups likely to benefit from decongestive or pulmonary hypertension-specific therapies and suggest areas for future research.
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Affiliation(s)
- Faeq Husain-Syed
- Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Internal Medicine II, Division of Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,International Renal Research Institute of Vicenza, Via Rodolfi, 37-36100, Vicenza, Italy
| | - Hermann-Josef Gröne
- Department of Pharmacology, University of Marburg, Karl-von-Frisch-Strasse, 35043, Marburg, Germany
| | - Birgit Assmus
- Department of Internal Medicine I, Division of Cardiology and Angiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
| | - Pascal Bauer
- Department of Internal Medicine I, Division of Cardiology and Angiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine II, Division of Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Member of the German Centre for Lung Research (DZL), Universities of Giessen and Marburg Lung Centre (UGMLC), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Internal Medicine II, Division of Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Member of the German Centre for Lung Research (DZL), Universities of Giessen and Marburg Lung Centre (UGMLC), Giessen, Germany.,Institute for Lung Health (ILH), Justus Liebig Medical University, Ludwigstrasse 23, 35390, Giessen, Germany.,The Cardio-Pulmonary Institute, Aulweg 130, 35392, Giessen, Germany.,Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, 61231, Bad Nauheim, Germany
| | - Ardeschir Ghofrani
- Department of Internal Medicine II, Division of Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Member of the German Centre for Lung Research (DZL), Universities of Giessen and Marburg Lung Centre (UGMLC), Giessen, Germany.,Department of Pulmonology, Kerckhoff Heart, Rheuma and Thoracic Centre, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.,Department of Medicine, Imperial College London, London, UK
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Via Rodolfi, 37-36100, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37-36100, Vicenza, Italy.,Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2-35128, Padua, Italy
| | - Horst-Walter Birk
- Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
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16
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Hoffmann J, Luxan G, Abplanalp W, Rasper T, Fischer A, Muhly-Reinholz M, Assmus B, Zeiher A, Dimmeler S. Myocardial infarction triggers Inflammatory deterioration of vascular niche by accelerating loss of a specific vessel subtype in bone. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The interface between heart and bone emerges as a key trigger of post-infarction inflammation and progression of chronic heart failure (CHF). However, our knowledge on the underlying mechanisms of this interaction is incomplete. Bone vasculature, specifically so-called H-type (Endomucinhigh) endothelial cells (EC), plays a crucial role in maintenance of the bone integrity and regulation of hematopoietic stem cells (HSC). While previous studies in mice showed the reduction of H-type vessels by aging, the impact of ischemic heart disease is unclear. Therefore, we aimed to investigate the effects of myocardial infarction (MI) and chronic heart failure on the vascular bone cell composition in mice and humans.
Methods and results
Flow cytometric analysis of harvested bones at the different timepoints after MI induction in mice revealed a gradual loss of H-type endothelial cells in the time-course of developing chronic heart failure (P<0.05 at day 7 and 14 vs. control; P<0.0001 at day 28 vs. control). This results were confirmed in immunostainings of tibia sections showing a significant decrease of H-type vessel length after MI (p<0.05 at day 14 and 28, accordingly). The loss of type-H endothelium was accompanied by a significant expansion of long-term HSC in the bone (P=0.0005 at day 28 post MI vs. control). Importantly, type H ECs were also significantly reduced in the bone of ischemic post-infarct HF patients (n=16) compared with control subjects (n=8; P=0.0003). To gain insights into the mechanisms underlying the changes in the vascular niche, we performed single cells RNA sequencing of human BM ECs. These studies confirmed the decrease in Emcnexpressing ECs in ischemic HF patients, which was accompanied by significantly increased expression of inflammatory genes, including IL1b (P<0.0001). Inflammatory EC phenotypes and IL1b expression in HF could be further confirmed at protein level using cytospin immunostainings. Murine studies further revealed an early induction IL-1b specifically in H-type vessels already at day 1 after MI induction, which preceded the loss of H-type endothelium within the following 4 weeks. By inhibiting IL-1b production using a specific Nlrp3 inflammasome inhibitor (MCC950) we could observe a partial restoration of H-type EC frequencies (P=0.033) and a significant increase in H-type vessel length (p=0.035) at day 28 day after MI.
Conclusions
Our data show for the first time an impact of myocardial infarction and chronic heart failure on the bone marrow vasculature. These changes seem to be strongly associated with inflammatory response in H-type vessels, which precedes its loss after MI. Specifically, the induction of the inflammatory cytokine IL1b may contribute to the disturbed phenotype. This suggest that inhibition of IL1b (e.g. by canakinumab) be used as a novel strategy to prevent or reverse the deterioration of the vascular bone function in ischemic heart disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Hoffmann
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - G Luxan
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - W.T Abplanalp
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - T Rasper
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - A.M Fischer
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - M Muhly-Reinholz
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - B Assmus
- Department of Cardiology, University of Giessen, Medical Clinic I, Giessen, Germany
| | - A.M Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Dimmeler
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
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17
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Kiefer K, Cremer S, Pardali E, Abou-El-Ardat K, Kirschbaum K, Dorsheimer L, Rasper T, Assmus B, Serve H, Dimmeler S, Zeiher A, Rieger M. Somatic blood cell mutations at low variant allele frequency in distinct risk genes are associated with increased mortality in patients with chronic ischemic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Recurrent somatic mutations in blood stem cells cause the emergence of mutated blood cell clones, known as clonal hematopoiesis (CH). Mutations in the most prevalent driver genes DNMT3A and TET2 with a variant allele frequency (VAF)≥2% have been associated with atherosclerosis and chronic heart failure (CHF). However, the effects of mutations in other driver genes for CH with low VAF (<2%) on CHF is still unknown.
Purpose
To assess the potential prognostic significance of mutations in distinct genes other than DNMT3A and TET2 causing CH at low VAF in patients with CHF due to post-ischemic origin.
Methods
We analyzed mononuclear bone marrow and peripheral blood cells from 400 CHF patients by deep error-corrected targeted amplicon sequencing allowing for the detection of very low VAF of ≥0.5% in 56 CH driver genes and associated such with the long-term mortality in these patients.
Results
Median age of the patients was 63 and median follow-up time was 4.8 years. We detected 1116 mutations with a VAF≥0.5% in 348 of 400 patients (87%). 21% of the patients carried 1 mutation, whereas 66% showed 2 and more mutations. Only 52 (13%) patients had no detectable mutation at all. Despite a high prevalence of mutations in the most frequently mutated driver genes DNMT3A (165 patients) and TET2 (107 pts), mutations in the genes CBL (8 pts), CEBPA (10 pts), PHF6 (22 pts), SMC1A (18 pts) and SRSF2 (14 pts) were associated with increased death compared to the average death rate of all patients (18.8%). To avoid confounding effects caused by the presence of DNMT3A and TET2 CHIP mutations, we excluded patients with DNMT3A-, TET2- and other CHIP-related mutations with a VAF≥2% for further analyses. Kaplan-Meier survival curve analyses revealed a significantly higher mortality in patients with mutations in either of the five genes, combined as the CH risk gene set for CHF (Fig. 1). Patients with mutations in the risk gene set (44 pts) did not differ from patients with mutations in other CH driver genes or without mutations with respect to age, cardiovascular risk factors, disease severity or CH clone size. By multivariate Cox proportional regression analysis, including the Seattle heart failure model (SHFM) score (as tertiles), death remained independently associated with the presence of mutations in the risk gene set (HR, 2.57; 95% CI, 1.30–5.10; p=0.007), in addition to SHFM score tertiles (tertile 2, HR, 2.36; 95% CI, 0.73–7.65 and tertile 3, HR, 7.96; 95% CI, 2.77–22.90).
Conclusions
Somatic mutations with low VAF in a distinct set of genes, namely in CBL, CEBPA, PHF6, SMC1A and SRSF2, are significantly associated with mortality in CHF, independently of the classical CHIP-driver mutations DNMT3A and TET2. Mutations in the CH risk gene set are prevalent in young CHF patients and comprise an independent risk factor for the outcome of CHF, potentially providing a novel tool for cardiovascular risk assessment and precision medicine in CHF.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG)
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Affiliation(s)
- K Kiefer
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
| | - S Cremer
- Goethe University Hospital Frankfurt, Department of Medicine, Cardiology, Frankfurt am Main, Germany
| | - E Pardali
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
| | - K Abou-El-Ardat
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
| | - K Kirschbaum
- Goethe University Hospital Frankfurt, Department of Medicine, Cardiology, Frankfurt am Main, Germany
| | - L Dorsheimer
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
| | - T Rasper
- Johann Wolfgang Goethe University, Institute for Cardiovascular Regeneration, Frankfurt am Main, Germany
| | - B Assmus
- University Hospital Giessen and Marburg, Department of Medicine, Cardiology, Giessen, Germany
| | - H Serve
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
| | - S Dimmeler
- Johann Wolfgang Goethe University, Institute for Cardiovascular Regeneration, Frankfurt am Main, Germany
| | - A Zeiher
- Goethe University Hospital Frankfurt, Department of Medicine, Cardiology, Frankfurt am Main, Germany
| | - M Rieger
- Goethe University Hospital Frankfurt, Department of Medicine, Hematology Oncology, Frankfurt am Main, Germany
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18
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Angermann CE, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett M, Brugts JJ, Ertl G, Ginn G, Hilker L, Koehler F, Rosenkranz S, Zhou Q, Adamson PB, Böhm M. Pulmonary artery pressure‐guided therapy in ambulatory patients with symptomatic heart failure: the
CardioMEMS E
uropean
M
onitoring
S
tudy for
H
eart
F
ailure (
MEMS‐HF
). Eur J Heart Fail 2020; 22:1891-1901. [DOI: 10.1002/ejhf.1943] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christiane E. Angermann
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
- Department of Medicine I, Cardiology/Angiology University Hospital Giessen Germany
| | - Stefan D. Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin‐Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
| | - Folkert W. Asselbergs
- Division Heart & Lungs, Department of Cardiology University Medical Centre Utrecht Utrecht The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology Coburg Germany
| | | | - Jasper J. Brugts
- Erasmus MC University Medical Centre, Thoraxcenter Rotterdam The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg‐Western Pommerania Karlsburg Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine Charité Universitätsmedizin Berlin Berlin Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC) Cologne Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I University Heart Center Freiburg – Bad Krozingen, University of Freiburg Freiburg Germany
- Department of Cardiology University Hospital Basel Basel Switzerland
| | | | - Michael Böhm
- Internal Medicine III Cardiology, Angiology, Intensive Care Saarland University Medical Centre Homburg Germany
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19
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Cremer S, Kirschbaum K, Berkowitsch A, John D, Kiefer K, Dorsheimer L, Wagner J, Rasper T, Abou-El-Ardat K, Assmus B, Serve H, Rieger M, Dimmeler S, Zeiher AM. Multiple Somatic Mutations for Clonal Hematopoiesis Are Associated With Increased Mortality in Patients With Chronic Heart Failure. Circ Genom Precis Med 2020; 13:e003003. [PMID: 32598856 DOI: 10.1161/circgen.120.003003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sebastian Cremer
- Institute for Cardiovascular Regeneration (S.C., D.J., J.W., T.R., S.D.), Goethe University, Frankfurt.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main) (S.C., B.A., S.D., A.M.Z.)
| | - Klara Kirschbaum
- Departments of Medicine and Cardiology (S.C., K. Kirschbaum, A.B., B.A., A.M.Z.), Goethe University, Frankfurt
| | - Alexander Berkowitsch
- Departments of Medicine and Cardiology (S.C., K. Kirschbaum, A.B., B.A., A.M.Z.), Goethe University, Frankfurt
| | - David John
- Institute for Cardiovascular Regeneration (S.C., D.J., J.W., T.R., S.D.), Goethe University, Frankfurt
| | - Katharina Kiefer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital (K. Kiefer, L.D., K.A.-E.A., H.S., M.R.), Goethe University, Frankfurt
| | - Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital (K. Kiefer, L.D., K.A.-E.A., H.S., M.R.), Goethe University, Frankfurt
| | - Julian Wagner
- Institute for Cardiovascular Regeneration (S.C., D.J., J.W., T.R., S.D.), Goethe University, Frankfurt
| | - Tina Rasper
- Institute for Cardiovascular Regeneration (S.C., D.J., J.W., T.R., S.D.), Goethe University, Frankfurt
| | - Khalil Abou-El-Ardat
- Department of Medicine, Hematology/Oncology, Goethe University Hospital (K. Kiefer, L.D., K.A.-E.A., H.S., M.R.), Goethe University, Frankfurt
| | - Birgit Assmus
- Departments of Medicine and Cardiology (S.C., K. Kirschbaum, A.B., B.A., A.M.Z.), Goethe University, Frankfurt.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main) (S.C., B.A., S.D., A.M.Z.).,Department of Medicine, Cardiology, Gießen University Hospital, Frankfurt (B.A.)
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, Goethe University Hospital (K. Kiefer, L.D., K.A.-E.A., H.S., M.R.), Goethe University, Frankfurt
| | - Michael Rieger
- Department of Medicine, Hematology/Oncology, Goethe University Hospital (K. Kiefer, L.D., K.A.-E.A., H.S., M.R.), Goethe University, Frankfurt
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration (S.C., D.J., J.W., T.R., S.D.), Goethe University, Frankfurt
| | - Andreas M Zeiher
- Departments of Medicine and Cardiology (S.C., K. Kirschbaum, A.B., B.A., A.M.Z.), Goethe University, Frankfurt.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main) (S.C., B.A., S.D., A.M.Z.)
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20
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Abplanalp WT, John D, Cremer S, Assmus B, Dorsheimer L, Hoffmann J, Becker-Pergola G, Rieger MA, Zeiher AM, Vasa-Nicotera M, Dimmeler S. Single-cell RNA-sequencing reveals profound changes in circulating immune cells in patients with heart failure. Cardiovasc Res 2020; 117:484-494. [PMID: 32311026 DOI: 10.1093/cvr/cvaa101] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 01/28/2023] Open
Abstract
AIMS Identification of signatures of immune cells at single-cell level may provide novel insights into changes of immune-related disorders. Therefore, we used single-cell RNA-sequencing to determine the impact of heart failure on circulating immune cells. METHODS AND RESULTS We demonstrate a significant change in monocyte to T-cell ratio in patients with heart failure, compared to healthy subjects, which were validated by flow cytometry analysis. Subclustering of monocytes and stratification of the clusters according to relative CD14 and FCGR3A (CD16) expression allowed annotation of classical, intermediate, and non-classical monocytes. Heart failure had a specific impact on the gene expression patterns in these subpopulations. Metabolically active genes such as FABP5 were highly enriched in classical monocytes of heart failure patients, whereas β-catenin expression was significantly higher in intermediate monocytes. The selective regulation of signatures in the monocyte subpopulations was validated by classical and multifactor dimensionality reduction flow cytometry analyses. CONCLUSION Together this study shows that circulating cells derived from patients with heart failure have altered phenotypes. These data provide a rich source for identification of signatures of immune cells in heart failure compared to healthy subjects. The observed increase in FABP5 and signatures of Wnt signalling may contribute to enhanced monocyte activation.
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Affiliation(s)
- Wesley T Abplanalp
- Department of Molecular Medicine, Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - David John
- Department of Molecular Medicine, Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Sebastian Cremer
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany
| | - Jedrzej Hoffmann
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | | | - Michael A Rieger
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany.,Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas M Zeiher
- German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany.,Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Mariuca Vasa-Nicotera
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany.,Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Stefanie Dimmeler
- Department of Molecular Medicine, Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
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21
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Dorsheimer L, Assmus B, Rasper T, Ortmann CA, Ecke A, Abou-El-Ardat K, Schmid T, Brüne B, Wagner S, Serve H, Hoffmann J, Seeger F, Dimmeler S, Zeiher AM, Rieger MA. Association of Mutations Contributing to Clonal Hematopoiesis With Prognosis in Chronic Ischemic Heart Failure. JAMA Cardiol 2020; 4:25-33. [PMID: 30566180 PMCID: PMC6439691 DOI: 10.1001/jamacardio.2018.3965] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Question What is the clinical significance of clonal hematopoiesis of indeterminate potential (CHIP) for chronic heart failure (CHF) owing to ischemic origin? Findings In this cohort study, CHIP had a high prevalence in 200 investigated patients with CHF. While no clinical baseline characteristics associated with CHF were different between CHIP carriers and non-CHIP carriers, except for the mean age, harboring mutations in the most prevalent driver genes associated with CHIP, namely DNMT3A and TET2, was associated with a significant and profound increase in death and rehospitalization for heart failure. Meaning Clonal hematopoiesis of indeterminate potential is presented as a newly identified risk factor for impaired long-term survival and increased disease progression in patients with CHF that may be well targetable as a valuable approach to precision medicine in patients with CHF carrying specific mutations encoding for clonal hematopoiesis. Importance Somatic mutations causing clonal expansion of hematopoietic cells (clonal hematopoiesis of indeterminate potential [CHIP]) are increased with age and associated with atherosclerosis and inflammation. Age and inflammation are the major risk factors for heart failure, yet the association of CHIP with heart failure in humans is unknown. Objective To assess the potential prognostic significance of CHIP in patients with chronic heart failure (CHF) owing to ischemic origin. Design, Setting, and Participants We analyzed bone marrow–derived mononuclear cells from 200 patients with CHF by deep targeted amplicon sequencing to detect the presence of CHIP and associated such with long-term prognosis in patients with CHF at University Hospital Frankfurt, Frankfurt, Germany. Data were analyzed between October 2017 and April 2018. Results Median age of the patients was 65 years. Forty-seven mutations with a variant allele fraction (VAF) of at least 0.02 were found in 38 of 200 patients with CHF (18.5%). The somatic mutations most commonly occurred in the genes DNMT3A (14 patients), TET2 (9 patients), KDM6A (4 patients), and BCOR (3 patients). Patients with CHIP were older and more frequently had a history of hypertension. During a median follow-up of 4.4 years, a total of 53 patients died, and 23 patients required hospitalization for heart failure. There was a significantly worse long-term clinical outcome for patients with either DNMT3A or TET2 mutations compared with non-CHIP carriers. By multivariable Cox proportional regression analysis, the presence of somatic mutations within TET2 or DNMT3A (HR, 2.1; 95% CI, 1.1-4.0; P = .02, for death combined with heart failure hospitalization) and age (HR, 1.04; 95% CI, 1.01-1.07 per year; P = .005) but not a history of hypertension remained independently associated with adverse outcome. Importantly, there was a significant dose-response association between VAF and clinical outcome. Conclusions and Relevance Our data suggest that somatic mutations in hematopoietic cells, specifically in the most commonly mutated CHIP driver genes TET2 and DNMT3A, may be significantly associated with the progression and poor prognosis of CHF. Future studies will have to validate our findings in larger cohorts and address whether targeting specific inflammatory pathways may be valuable for precision medicine in patients with CHF carrying specific mutations encoding for CHIP.
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Affiliation(s)
- Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Germany
| | - Tina Rasper
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
| | - Christina A Ortmann
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Andreas Ecke
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Khalil Abou-El-Ardat
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Tobias Schmid
- Institute for Biochemistry I, Goethe University Hospital, Frankfurt, Germany
| | - Bernhard Brüne
- Institute for Biochemistry I, Goethe University Hospital, Frankfurt, Germany
| | - Sebastian Wagner
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Jedrzej Hoffmann
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Germany
| | - Florian Seeger
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Germany.,Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.,German Center for Cardiovascular Research, Berlin (partner site Frankfurt Rhine-Main), Germany
| | - Michael A Rieger
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
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22
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Dorsheimer L, Assmus B, Rasper T, Ortmann CA, Abou-El-Ardat K, Kiefer KC, Hoffmann J, Seeger F, Bonig H, Dimmeler S, Zeiher AM, Rieger MA. Hematopoietic alterations in chronic heart failure patients by somatic mutations leading to clonal hematopoiesis. Haematologica 2019; 105:e328-e332. [PMID: 31699791 DOI: 10.3324/haematol.2019.224402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lena Dorsheimer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt
| | - Birgit Assmus
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt
| | - Tina Rasper
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt
| | - Christina A Ortmann
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt
| | - Khalil Abou-El-Ardat
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg
| | - Katharina C Kiefer
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt
| | - Jedrzej Hoffmann
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt.,German Center for Cardiovascular Research DZHK, Berlin, partner site Frankfurt Rhine-Main
| | - Florian Seeger
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt
| | - Halvard Bonig
- Institute for Transfusion Medicine, Goethe University Hospital, Frankfurt
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt.,German Center for Cardiovascular Research DZHK, Berlin, partner site Frankfurt Rhine-Main
| | - Andreas M Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt.,German Center for Cardiovascular Research DZHK, Berlin, partner site Frankfurt Rhine-Main
| | - Michael A Rieger
- Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg.,Frankfurt Cancer Institute, Frankfurt, Germany
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23
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Kutyifa V, Erath JW, Burch A, Assmus B, Bondermann D, Russo AM. P3517Failure to achieve adequate heart rate control in women during therapy optimization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking.
Methods
The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months.
Results
There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure).
Figure 1
Conclusions
A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.
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Affiliation(s)
- V Kutyifa
- University of Rochester, Rochester, United States of America
| | - J W Erath
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Burch
- East Carolina Heart Institute, Greenville, United States of America
| | - B Assmus
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - A M Russo
- Cooper University Hospital, Camden, United States of America
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24
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Abplanalp W, John D, Assmus B, Dorscheimer L, Abou-El-Ardat K, Rieger M, Zeiher AM, Vasa-Nicotera M, Dimmeler S. 1437Single cell RNA sequencing reveals profound changes in monocytic cell clusters in patients with mutations associated with clonal hematopoiesis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Monocytes and macrophages have distinct roles in cardiovascular health where they may contribute to beneficial processes like wound healing and cardiac conductance or to pathological processes like inflammation, remodeling and fibrosis. Despite their importance, the specific signatures of circulating monocytes are missing. Single cell RNA sequencing (scRNA-seq) provides a novel opportunity to define subsets of monocytes mediating inflammation in humans.
Purpose
To detect and study the inflammatory burden driven by subsets of monocytes in healthy individuals and subjects with chronic ischemic heart failure (CHF) using scRNA-seq.
Methods and results
Circulating CD31+ cells of CHF patients (n=11) along with aged matched (n=3) and young healthy controls (n=5) were sorted and scRNA-seq then performed. Unsupervised clustering of present sequencing data revealed these cells to be comprised of 19 subpopulations (primarily monocytes). Many subpopulations of cells were comprised chiefly or solely by CHF subjects. Dysregulated genes in CHF subjects, relative to healthy controls included interleukin-1b, thrombospondin-1, S100A8 and matrix metalloprotease-1, which were confirmed by FACS and qRT-PCR in a validation cohort. Given the expanded, divergent and highly inflammatory transcriptional populations of monocytes in patients with CHF, we assessed whether occurrence of somatic mutations associated with clonal hematopoiesis of indeterminate potential (CHIP), recently shown to be increased in subjects with atherosclerosis and heart failure, might occur in these subjects. Indeed, we identified patients who revealed mutations in the DNA methyltransferase DNMT3A and other CHIP-driver genes. DNMT3A mutations were associated with changes in known DNMT3A target genes such as the pro-inflammatory genes CXCL1, CXCL2 and IL6 in circulating monocytic cells. Moreover, cell fate trajectory analysis showed shared fates of cells driven by pseudotime-dependent variables from subjects harboring DNMT3A mutations. Regulated genes in this fate were associated with cell survival, migration and inflammation, appropriate for this disease phenotype.
Conclusions
This is the first study to show scRNA-seq profiles of monocytes in patients with CHF. Healthy subjects displayed remarkable homogeneity in their transcriptional profiles. CHF subjects show changes in inflammatory gene expression. CHF subjects with clonal hematopoiesis share signature gene expression profiles driving similar cell fates. Subjects with CHF of ischemic origin harboring DNMT3A mutations have a worse prognosis than non-CHIP carrier CHF controls. Identification of early alterations in immune cell subsets recognized by single cell sequencing and genetic testing of CHIP mutations may detect subjects with a high risk and allow for a precision treatment of the immune disorders.
Acknowledgement/Funding
SFB834
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Affiliation(s)
- W Abplanalp
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - D John
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - B Assmus
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - L Dorscheimer
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - M Rieger
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A M Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - S Dimmeler
- Wolfgang Goethe University, Frankfurt am Main, Germany
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25
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Erath JW, Kutyifa V, Assmus B, Burch A, Bondermann D, Russo A. P2281Inadequate heart rate control begets sustained ventricular arrhythmias in a large cohort of women. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Wearable Cardioverter Defibrillator (WCD) is an effective therapy for treating ventricular arrhythmias (VT/VF) in at-risk patients, while providing continuous heart rate (HR) monitoring. Because women are under-represented in defibrillator trials, we chose to specifically focus on HR control in women prior to VT/VF events.
Purpose
To evaluate HR profiles preceding sustained VT/VF in women fitted with a WCD.
Methods
Data from women fitted with WCD (≥30 days use) from 2015 to 2018 were obtained from the manufacturer's database. HR is expressed as a weekly resting nighttime median (midnight to 7 am). Men (random sample) with the same inclusion criteria served as a control.
Results
A total of 21,440 women, age 67±15 years, were included for analysis. Over a median WCD use of 90 days (59–116 days), 118 women (0.6%) and 133 men (0.8%) received shocks for VT/VF (p=0.01). Resting HR one-week preceding VT/VF was above the target of 70bpm in 55% of shocked women (65 of 118) versus 44% of non-shocked women (9,272 of 21,322, p=0.01) (figure). HR one week before WCD shock was similar in women and men (71 bpm vs. 72 bpm; p=0.60). Younger women (≤50 years) had higher HR prior to shock than older women (HR 80 bpm vs. 70 bpm p=0.003). Among shocked patients, 24-hour-survival was 89% in women and 88% in men. During three-month follow-up, the same percentage of men and women died after receiving adequate WCD shock therapy (18%).
Heart rate profiles
Conclusions
Women with adequate heart rate control experienced significantly less spontaneous VT/VF than those with higher heart rates. The WCD can be utilized as a diagnostic tool to monitor HR in at-risk women in addition to treating sustained VT/VF.
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Affiliation(s)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - V Kutyifa
- University of Rochester, Department of Cardiology, Rochester, United States of America
| | - B Assmus
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - A Burch
- East Carolina Heart Institute, Department of Psychology and Cardiovascular Services, Greenville, United States of America
| | - D Bondermann
- Medical University of Vienna, Department of Internal Medicine, Vienna, Austria
| | - A Russo
- Cooper University Hospital, Department of Electrophysiology, Camden, United States of America
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26
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Hoffmann J, Abplanalp W, Rasper T, Fischer A, Assmus B, Wild P, Koeck T, Zeiher AM, Dimmeler S. 6091Chronic heart failure is associated with inflammatory deterioration of the bone marrow vascular niche. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Inflammation plays a crucial role in many aspects of cardiovascular disease. Particularly, acquired mutations of hematopoietic stem cells (HSC) leading to clonal expansion of inflammatory cells (CHIP) are increased with age and are associated with an enhanced risk of cardiovascular disease. The bone marrow (BM) vascular niche plays a crucial role in maintenance and regulation of HSC functions. Previous studies in mice showed the reduction of a specific Endomucin-high (H-type) endothelial cells (EC) subpopulation by aging. However, the impact of cardiovascular disease is unclear. Therefore, we aimed to investigate the effects of age and heart failure (HF) on the vascular BM cell composition in mice and humans.
Methods and results
Aging mice showed an age-dependent decrease of type H (Emcn-high) BM ECs (p=0.004), whereas the BM frequencies of type L (Emcn-low) ECs did not significantly differ (P=0.18). Importantly, we also observed a marked reduction of type H EC in chronic ischemic mice (P=0.016 vs. sham) indicating that chronic ischemic HF induces similar alterations of the vascular stem cell niche. Importantly, type H ECs were also significantly reduced in ischemic HF patients (n=16) compared with control subjects (n=8; P=0.0003). To gain insights into the mechanisms underlying the changes in the vascular niche, we performed single cells RNA sequencing of human BM ECs. These studies confirmed the decrease in Emcn-expressing ECs in ischemic HF patients, which was accompanied by significantly increased expression of inflammatory genes, including IL1b (P<0.0001 vs. control). Inflammatory EC phenotypes and IL1b expression in HF could be further confirmed at protein level using cytospin immunostainings. Finally, we comprehensively evaluated phenotype-associated differences in the bone marrow plasma proteomes of healthy individuals (n=19) and patients with chronic ischemic (n=22) and non-ischemic (n=19) HF, using proximity extension assays. Here, we identified 182 proteins significantly differentially regulated in CHF versus CTRL. Among the top upregulated proteins the BM environment of patients with CHF showed a striking enrichment of inflammatory and ECM remodeling components.
Conclusions
Our data show for the first time an impact of chronic heart failure on the bone marrow vascular niche in humans. These changes seem to be strongly associated with increased inflammatory response and bone matrix remodeling in CHF. Specifically, the induction of the inflammatory cytokine IL1b may contribute to the disturbed phenotype suggesting that inhibition of IL1b (e.g. by canakinumab) may be used as a novel strategy to prevent or reverse the deterioration of the vascular BM niche.
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Affiliation(s)
- J Hoffmann
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - W Abplanalp
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - T Rasper
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - A Fischer
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
| | - B Assmus
- Department of Cardiology, University of Giessen, Medical Clinic I, Giessen, Germany
| | - P Wild
- Johannes Gutenberg University Mainz (JGU), Preventive Cardiology and Preventive Medicine, Center for Cardiology, Mainz, Germany
| | - T Koeck
- Johannes Gutenberg University Mainz (JGU), Preventive Cardiology and Preventive Medicine, Center for Cardiology, Mainz, Germany
| | - A M Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Dimmeler
- JW Goethe University, Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Frankfurt am Main, Germany
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Burch AE, Kutyifa V, Erath JW, Assmus B, Bondermann D, Russo AM. P1462Return to physical activity among women following newly diagnosed dilated cardiomyopathy or myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Resuming activity following a new diagnosis of dilated cardiomyopathy (DCM) or myocardial infarction (MI) is important for improvements in morbidity and mortality. Activity is also associated with an improved ejection fraction (EF) and lower risk of reinfarction. Patient management could benefit from having normative values and expected gains in activity early following diagnosis of DCM or MI.
Purpose
Assess the change in activity among women for the first 30 days after hospital discharge following a new DCM diagnosis or MI.
Methods
Female adult patients prescribed a wearable cardioverter defibrillator (WCD) for a diagnosis of DCM (n=3550) or MI (n=1422) with low EF were included. Step count was measured by WCD accelerometer. Change in activity over time was analyzed, including weekly percentage gains.
Results
Women with DCM were significantly younger (64, SD = 13) than women post-MI (67, SD = 12). Median daily step count across the entire 30-day period was 4093 (IQR: 2123–6609). Women with DCM demonstrated a higher step count compared to women post-MI, 4405 (IQR: 2348–6986) and 3352 (IQR: 1644–5709), respectively, even after correcting for the difference in age between the groups. The greatest increases in activity for all occurred from week 1 to week 2. Women with DCM or post-MI had a 15.4% and 19.1% increase, respectively. Incremental increases in activity continued throughout the month.
Conclusion
Physical activity among women with newly diagnosed DCM or MI and a low EF increased within the first 30 days. The most significant increase occurred from week 1 to week 2. This data can be used as a benchmark to develop and assess prescriptive activity programs for women.
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Affiliation(s)
- A E Burch
- East Carolina Heart Institute, Psychology, Greenville, United States of America
| | - V Kutyifa
- University of Rochester, Medical Center, Rochester, United States of America
| | - J W Erath
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - B Assmus
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - D Bondermann
- Medical University of Vienna, Department of Internal Medicine, Vienna, Austria
| | - A M Russo
- Cooper University Hospital, Department of Internal Medicine, Camden, United States of America
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28
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Dorsheimer L, Assmus B, Rasper T, Abou-El-Ardat K, Bönig H, Hoffmann J, Ortmann CA, Seeger F, Dimmeler S, Zeiher AM, Rieger MA. THE ASSOCIATION OF CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL WITH CHRONIC ISCHEMIC HEART FAILURE. Exp Hematol 2019. [DOI: 10.1016/j.exphem.2019.06.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Mutlak H, Assmus B, Popov AF. Minimally invasive embolectomy of HeartWare left ventricular assist device outflow graft. J Thorac Dis 2019; 11:S957-S959. [PMID: 31183175 DOI: 10.21037/jtd.2019.03.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Haitham Mutlak
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Birgit Assmus
- Cardiology and Molecular Cardiology, Department of Medicine III, J.W. Goethe University of Frankfurt, Frankfurt, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.,Department of Thoracic and Cardiovascular Surgery, Eberhard Karls University, Tuebingen, Germany
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Ortmann CA, Dorsheimer L, Abou-El-Ardat K, Hoffrichter J, Assmus B, Bonig H, Scholz A, Pfeifer H, Martin H, Schmid T, Brüne B, Scheich S, Steffen B, Riemann J, Hermann S, Dukat A, Bug G, Brandts CH, Wagner S, Serve H, Rieger MA. Functional Dominance of CHIP-Mutated Hematopoietic Stem Cells in Patients Undergoing Autologous Transplantation. Cell Rep 2019; 27:2022-2028.e3. [DOI: 10.1016/j.celrep.2019.04.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/02/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
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Herrmann E, Ecke A, Fichtlscherer S, Zeiher AM, Assmus B. [Pulmonary artery pressure sensor for ambulatory assessment of ventricular filling pressure in advanced heart failure : What should be considered for the follow-up care?]. Herzschrittmacherther Elektrophysiol 2018; 29:393-400. [PMID: 30306304 DOI: 10.1007/s00399-018-0597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patients with advanced heart failure suffer from frequent hospitalizations. Noninvasive hemodynamic telemonitoring for assessment of pulmonary filling pressure has been shown to reduce hospitalizations. In this article, our experience with possible control intervals and the standardization of the follow-up care of hemodynamic telemonitoring is reported. METHODS A literature search and our own experience in the follow-up care concerning the implantable pulmonary artery pressure sensor for noninvasive hemodynamic telemonitoring in patients with advanced heart failure are presented. RESULTS For standardized follow-up care of heart failure patients with hemodynamic monitoring a specialized team consisting of a heart failure nurse and heart failure physician is essential. These teams should ideally work based on a unique standard operating procedure (SOP) to ensure standardized control intervals and a standardized approach to classical hemodynamic changes. However, all therapeutic recommendations have to be prescribed by a physician and must be modified if individually appropriate. CONCLUSION Optimized follow-up care for hemodynamically guided heart failure management requires the implementation of novel structures in the German health care system in order to transfer the clinical benefit from clinical trials into daily routine.
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Affiliation(s)
- Ester Herrmann
- Med. Klinik III, Kardiologie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - A Ecke
- Med. Klinik III, Kardiologie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - S Fichtlscherer
- Med. Klinik III, Kardiologie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - A M Zeiher
- Med. Klinik III, Kardiologie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - B Assmus
- Med. Klinik III, Kardiologie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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32
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Zwetsloot PP, Gremmels H, Assmus B, Koudstaal S, Sluijter JPG, Zeiher AM, Chamuleau SAJ. Responder Definition in Clinical Stem Cell Trials in Cardiology: Will the Real Responder Please Stand Up? Circ Res 2018; 119:514-8. [PMID: 27492842 DOI: 10.1161/circresaha.116.308733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Peter Paul Zwetsloot
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.).
| | - Hendrik Gremmels
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
| | - Birgit Assmus
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
| | - Stefan Koudstaal
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
| | - Joost P G Sluijter
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
| | - Andreas M Zeiher
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
| | - Steven A J Chamuleau
- From the Experimental Cardiology Laboratory, Department of Cardiology (P.P.Z., S.K., J.P.G.S., S.A.J.C.), Department of Nephrology and Hypertension (H.G., A.M.Z.), and UMC Utrecht Regenerative Medicine Center (J.P.G.S., S.A.J.C.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany (B.A.); and Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (J.P.G.S., S.A.J.C.)
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Herrmann E, Ecke A, Herrmann E, Eissing N, Fichtlscherer S, Zeiher AM, Assmus B. Daily non-invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure. ESC Heart Fail 2018; 5:780-787. [PMID: 29893475 PMCID: PMC6165961 DOI: 10.1002/ehf2.12303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/26/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022] Open
Abstract
AIM Patients with advanced systolic chronic heart failure frequently suffer from progressive functional mitral regurgitation. We report our initial experience in patients with an implanted pulmonary artery pressure (PAP) sensor, who developed severe mitral regurgitation, which was treated with the MitraClip system. We non-invasively compared changes in PAP values in patients after MitraClip with PAP changes in patients without MitraClip. METHODS AND RESULTS Among 28 patients with New York Heart Association III heart failure with implanted PAP sensor for haemodynamic telemonitoring from a single centre, four patients (age 66 ± 6 years, left ventricular ejection fraction 21 ± 3%, and cardiac index 1.8 ± 0.3) received a MitraClip procedure and were compared with 24 patients (age 72 ± 8 years, left ventricular ejection fraction 26 ± 9.9%, and cardiac index 2.0 ± 1.0) without MitraClip procedure in a descriptive manner. Ambulatory PAP values were followed for 90 days in both groups. In comparison with the PAP values 4 weeks before MitraClip procedure, PAP was profoundly reduced in all four patients after 30 days (ΔPAPmean -11 ± 5, ΔPAPdiast -7 ± 3 mmHg, P < 0.02) as well as after 90 days (ΔPAPmean -6.3 ± 6, ΔPAPdiast -1 ± 3 mmHg). Reductions in PAP were accompanied by a profound reduction in N terminal pro brain natriuretic peptide as well as clinical and echocardiographic improvement. When analysing the dynamics with a regression model, reductions in all PAP values were significantly greater after MitraClip compared with conservative haemodynamic monitoring (P < 0.001). CONCLUSIONS The efficacy of the interventional MitraClip procedure on clinical symptoms can be confirmed by haemodynamic telemonitoring. Thus, daily non-invasive haemodynamic telemonitoring allows, for the first time, for a continuous assessment of the haemodynamic efficacy of novel therapies in patients with chronic heart failure.
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Affiliation(s)
- Ester Herrmann
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Ecke
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research, DZHK, Berlin, Germany.,Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Eissing
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Birgit Assmus
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research, DZHK, Berlin, Germany
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34
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Angermann CE, Assmus B, Anker SD, Brachmann J, Ertl G, Köhler F, Rosenkranz S, Tschöpe C, Adamson PB, Böhm M. Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol 2018; 107:991-1002. [PMID: 29777373 DOI: 10.1007/s00392-018-1281-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Wireless monitoring of pulmonary artery (PA) pressures with the CardioMEMS HF™ system is indicated in patients with New York Heart Association (NYHA) class III heart failure (HF). Randomized and observational trials have shown a reduction in HF-related hospitalizations and improved quality of life in patients using this device in the United States. OBJECTIVE MEMS-HF is a prospective, non-randomized, open-label, multicenter study to characterize safety and feasibility of using remote PA pressure monitoring in a real-world setting in Germany, The Netherlands and Ireland. METHODS AND RESULTS After informed consent, adult patients with NYHA class III HF and a recent HF-related hospitalization are evaluated for suitability for permanent implantation of a CardioMEMS™ sensor. Participation in MEMS-HF is open to qualifying subjects regardless of left ventricular ejection fraction (LVEF). Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy as tolerated. The study will enroll 230 patients in approximately 35 centers. Expected duration is 36 months (24-month enrolment plus ≥ 12-month follow-up). Primary endpoints are freedom from device/system-related complications and freedom from pressure sensor failure at 12-month post-implant. Secondary endpoints include the annualized rate of HF-related hospitalization at 12 months versus the rate over the 12 months preceding implant, and health-related quality of life. Endpoints will be evaluated using data obtained after each subject's 12-month visit. CONCLUSIONS The MEMS-HF study will provide robust evidence on the clinical safety and feasibility of implementing haemodynamic monitoring as a novel disease management tool in routine out-patient care in selected European healthcare systems. TRIAL REGISTRATION ClinicalTrials.gov; NCT02693691.
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Affiliation(s)
- Christiane E Angermann
- Department of Medicine I, Cardiology, and Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism and Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology & Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | | | - Georg Ertl
- Department of Medicine I, Cardiology, and Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | | | | | | | | | - Michael Böhm
- Saarland University Medical Center, Homburg, Germany
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35
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Mathur A, Arnold R, Assmus B, Bartunek J, Belmans A, Bönig H, Crea F, Dimmeler S, Dowlut S, Fernández-Avilés F, Galiñanes M, Garcia-Dorado D, Hartikainen J, Hill J, Hogardt-Noll A, Homsy C, Janssens S, Kala P, Kastrup J, Martin J, Menasche P, Miklik R, Mozid A, San Román JA, Sanz-Ruiz R, Tendera M, Wojakowski W, Ylä-Herttuala S, Zeiher A. The effect of intracoronary infusion of bone marrow-derived mononuclear cells on all-cause mortality in acute myocardial infarction: rationale and design of the BAMI trial. Eur J Heart Fail 2017; 19:1545-1550. [PMID: 28948706 PMCID: PMC6607485 DOI: 10.1002/ejhf.829] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 12/20/2022] Open
Abstract
Over the past 13 years bone marrow‐derived mononuclear cells (BM‐MNCs) have been widely investigated for clinical efficacy in patients following acute myocardial infarction (AMI). These early phase II trials have used various surrogate markers to judge efficacy and, although promising, the results have been inconsistent. The phase III BAMI trial has therefore been designed to demonstrate that intracoronary infusion of BM‐MNCs is safe and will significantly reduce the time to first occurrence of all‐cause death in patients with reduced left ventricular ejection fraction after successful reperfusion for ST‐elevation AMI (powered with the aim of detecting a 25% reduction in all‐cause mortality). This is a multinational, multicentre, randomized, open‐label, controlled, parallel‐group phase III study aiming to enrol approximately 3000 patients in 11 European countries with at least 17 sites. Eligible patients who have impaired left ventricular ejection (≤45%) following successful reperfusion for AMI will be randomized to treatment or control group in a 1:1 ratio. The treatment group will receive intracoronary infusion of BM‐MNCs 2–8 days after successful reperfusion for AMI added on top of optimal standard of care. The control group will receive optimal standard of care. The primary endpoint is time from randomization to all‐cause death. The BAMI trial is pivotal and the largest trial to date of BM‐MNCs in patients with impaired left ventricular function following AMI. The aim of the trial is to provide a definitive answer as to whether BM‐MNCs reduce all‐cause mortality in this group of patients.
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Affiliation(s)
| | - Roman Arnold
- ICICORELAB, Hospital Clínico Universitario, Valladolid, Spain
| | - Birgit Assmus
- Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Jozef Bartunek
- VZW Cardiovascular Research Center Aalst, Aalst, Belgium
| | - Ann Belmans
- KU Leuven-University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Halvard Bönig
- Johann-Wolfgang-Goethe University, Frankfurt and DRK-Blutspendedienst BaWüHe, Germany
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | - Manuel Galiñanes
- Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain
| | - David Garcia-Dorado
- Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Juha Hartikainen
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | | | | | | | | | - Petr Kala
- Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Jens Kastrup
- Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | | | - Philippe Menasche
- Assistance Publique Hopitaux de Paris, University Paris Descartes, Paris, France
| | - Roman Miklik
- Faculty Hospital and Masaryk University, Brno, Czech Republic
| | | | | | | | | | | | - Seppo Ylä-Herttuala
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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36
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De Rosa R, Schranz D, Vasa-Nicotera M, Assmus B, Risteski P, Moritz A, Zeiher AM, Fichtlscherer S. Percutaneous Therapy of a Stenotic Parachute Mitral Valve Previously Treated by Surgery. J Heart Valve Dis 2017; 26:488-491. [PMID: 29302951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Parachute mitral valve (PMV) is a congenital heart anomaly which consists of a unifocal attachment of the mitral valve chordae into a single or dominant papillary muscle. This morphological anomaly determines the impairment of mitral leaflet motion, resulting in different grades of mitral stenosis. Due to its frequent association with other congenital cardiac defects requiring surgical correction, the therapy of a relevant stenotic PMV is usually represented by surgical commissurotomy. Herein is reported the case of a PMV treated by surgery in infancy, which showed a severe restenosis after 34 years and was successfully treated by percutaneous valvuloplasty with the additional creation of a restrictive atrial communication.
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Affiliation(s)
- Roberta De Rosa
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany. Electronic correspondence:
| | - Dietmar Schranz
- Hessisches Kinderherzzentrum and Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Birgit Assmus
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Petar Risteski
- Division of Thoracic and Cardiovascular Surgery, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anton Moritz
- Division of Thoracic and Cardiovascular Surgery, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
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37
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Luu B, Leistner DM, Herrmann E, Seeger FH, Honold J, Fichtlscherer S, Zeiher AM, Assmus B. Minute Myocardial Injury as Measured by High-Sensitive Troponin T Serum Levels Predicts the Response to Intracoronary Infusion of Bone Marrow-Derived Mononuclear Cells in Patients With Stable Chronic Post-Infarction Heart Failure: Insights From the TOPCARE-CHD Registry. Circ Res 2017; 120:1938-1946. [PMID: 28351842 DOI: 10.1161/circresaha.116.309938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/16/2017] [Accepted: 03/27/2017] [Indexed: 12/13/2022]
Abstract
RATIONALE Cell-based therapies are a promising option in patients with chronic postinfarction heart failure (ischemic cardiomyopathy [ICM]). However, the responses after intracoronary infusion of autologous bone marrow-derived mononuclear cells (BMCs) are heterogeneous, which may be related to impaired cell retention in patients with ICM. Ischemic injury is associated with upregulation of prototypical chemoattractant cytokines mediating retention and homing of circulating cells. The development of ultrasensitive tests to measure high-sensitive troponin T (hs-TnT) serum levels revealed the presence of ongoing minute myocardial injury even in patients with stable ICM. OBJECTIVE To test the hypothesis that serum levels of hs-TnT correlate with cell retention and determine the response to intracoronary BMC application in patients with ICM. METHODS AND RESULTS About 157 patients with stable ICM and no substantial impairment of kidney function received intracoronary BMC administration. Immediately prior to cell application, hs-TnT levels to measure myocardial injury and NT-proBNP levels as marker of left ventricular wall stress were determined. Patients with elevated hs-TnT were older and had more severe heart failure. Importantly, only patients with elevated baseline hs-TnT≥15.19 pg/mL (upper tertile) demonstrated a significant (P=0.04) reduction in NT-proBNP serum levels (-250 [-1465; 33] pg/mL; relative reduction -24%) 4 months after BMC administration, whereas NT-proBNP levels remained unchanged in patients in the 2 lower hs-TnT tertiles. The absolute decrease in NT-proBNP at 4 months was inversely correlated with baseline hs-TnT (r=-0.27, P=0.001). Finally, retention of intracoronarily infused, 111Indium-labeled cells within the heart was closely associated with hs-TnT levels in patients with chronic ischemic heart failure (P=0.0008, n=10, triple measurements). CONCLUSIONS The extent of ongoing myocardial injury as measured by serum levels of hs-TnT predicts the reduction of NT-proBNP serum levels at 4 months after intracoronary BMC administration in patients with ICM, suggesting that the beneficial effects of BMC application on LV remodeling and wall stress are confined to patients with ongoing minute myocardial injury. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT00962364.
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Affiliation(s)
- Brigitte Luu
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - David M Leistner
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Eva Herrmann
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Florian H Seeger
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Joerg Honold
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Stephan Fichtlscherer
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Andreas M Zeiher
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Birgit Assmus
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.).
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38
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Derlet A, Rasper T, Roy Choudhury A, Bothur S, Rieger MA, Namgaladze D, Fischer A, Schürmann C, Brandes RP, Tschulena U, Steppan S, Assmus B, Dimmeler S, Zeiher AM, Seeger FH. Metabolism Regulates Cellular Functions of Bone Marrow-Derived Cells used for Cardiac Therapy. Stem Cells 2016; 34:2236-48. [PMID: 27145479 DOI: 10.1002/stem.2394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/27/2016] [Accepted: 03/30/2016] [Indexed: 01/07/2023]
Abstract
Administration of bone marrow-derived mononuclear cells (BMC) may increase cardiac function after myocardial ischemia. However, the functional capacity of BMC derived from chronic heart failure (CHF) patients is significantly impaired. As modulation of the energy metabolism allows cells to match the divergent demands of the environment, we examined the regulation of energy metabolism in BMC from patients and healthy controls (HC). The glycolytic capacity of CHF-derived BMC is reduced compared to HC, whereas BMC of metabolically activated bone marrow after acute myocardial infarction reveal increased metabolism. The correlation of metabolic pathways with the functional activity of cells indicates an influence of metabolism on cell function. Reducing glycolysis without profoundly affecting ATP-production reversibly reduces invasion as well as colony forming capacity and abolishes proliferation of CD34(+) CD38(-) lin(-) hematopoietic stem and progenitor cells (HSPC). Ex vivo inhibition of glycolysis further reduced the pro-angiogenic activity of transplanted cells in a hind limb ischemia model in vivo. In contrast, inhibition of respiration, without affecting total ATP production, leads to a compensatory increase in glycolytic capacity correlating with increased colony forming capacity. Isolated CD34(+) , CXCR4(+) , and CD14(+) cells showed higher glycolytic activity compared to their negative counterparts. Metabolic activity was profoundly modulated by the composition of media used to store or culture BMC. This study provides first evidence that metabolic alterations influence the functional activity of human HSPC and BMC independent of ATP production. Changing the balance between respiration and glycolysis might be useful to improve patient-derived cells for clinical cardiac cell therapy. Stem Cells 2016;34:2236-2248.
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Affiliation(s)
- Anja Derlet
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
| | - Tina Rasper
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
| | - Aaheli Roy Choudhury
- LOEWE Center for Cell and Gene Therapy, Internal Medicine III, Goethe University, Hematology/Oncology
| | - Sabrina Bothur
- LOEWE Center for Cell and Gene Therapy, Internal Medicine III, Goethe University, Hematology/Oncology
| | - Michael A Rieger
- LOEWE Center for Cell and Gene Therapy, Internal Medicine III, Goethe University, Hematology/Oncology
| | - Dmitry Namgaladze
- Faculty of Medicine, Institute of Biochemistry I/ZAFES, Goethe University
| | - Ariane Fischer
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
| | - Christoph Schürmann
- Faculty of Medicine, Institute for Cardiovascular Physiology, Goethe University
| | - Ralf P Brandes
- Faculty of Medicine, Institute for Cardiovascular Physiology, Goethe University
| | - Ulrich Tschulena
- Department for Biomedical Research and Project Evaluation, Fresenius Medical Care Deutschland GmbH, Goethe University, Bad Homburg, Germany
| | - Sonja Steppan
- Department for Biomedical Research and Project Evaluation, Fresenius Medical Care Deutschland GmbH, Goethe University, Bad Homburg, Germany
| | - Birgit Assmus
- Department of Cardiology, Internal Medicine III, Goethe University, Frankfurt (Main), Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
| | - Andreas M Zeiher
- Department of Cardiology, Internal Medicine III, Goethe University, Frankfurt (Main), Germany
| | - Florian H Seeger
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University.,Department of Cardiology, Internal Medicine III, Goethe University, Frankfurt (Main), Germany
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39
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Assmus B, Alakmeh S, De Rosa S, Bönig H, Hermann E, Levy WC, Dimmeler S, Zeiher AM. Improved outcome with repeated intracoronary injection of bone marrow-derived cells within a registry: rationale for the randomized outcome trial REPEAT. Eur Heart J 2015; 37:1659-66. [PMID: 26516172 DOI: 10.1093/eurheartj/ehv559] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/04/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Regenerative therapies have evolved as a promising new option in the treatment of post-infarction heart failure. A major limitation of intracoronary application of autologous bone marrow-derived mononuclear cells (BM-MNCs) is that homing of the applied cells is profoundly reduced in patients with post-infarction heart failure compared with patients with acute myocardial infarction. However, early pilot and also randomized controlled trials have demonstrated significant improvements in overall cardiac function. The aim of the present analysis was to quantify a potential mortality risk reduction and reduced hospitalization in order to provide data for a prospective outcome trial. METHODS AND RESULTS The results of an ongoing single-centre registry including 297 post-infarction heart failure patients suggest that repeated intracoronary application of autologous bone marrow-derived cells is associated with a significant better 2-year survival compared with a single BM-MNC application (2-year survival 93.6 vs. 84.0%, P = 0.03). Likewise, mortality is significantly lower at 2-year follow-up compared with the mortality estimated by the use of the Seattle Heart Failure Model (SHFM) in patients receiving repeated BM-MNC application (observed mortality 6.4%, predicted mortality 16.2%, P = 0.02). Although the trend persisted at 3-year follow-up, the mortality reduction was no longer statistically significant between single and repeated treatment (mortality 21.9 vs. 13.7%, P = 0.06). CONCLUSION Repeated intracoronary administration of BM-MNC appears to be associated with improved clinical outcome compared with single treatment at 2 years. This registry provides the rationale for the design of the multicentre randomized, controlled, open-label REPEAT trial, which prospectively compares the effects of single vs. repeated intracoronary application of autologous BM-MNC on total and SHFM-predicted mortality in patients with chronic post-infarction heart failure.
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Affiliation(s)
- Birgit Assmus
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany
| | - Samer Alakmeh
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Halvard Bönig
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology Goethe University, Frankfurt, Germany
| | - Eva Hermann
- German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt, Germany
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany Institute for Cardiovascular Regeneration, Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany German Center for Cardiovascular Research DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany
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Kornberger A, Walter V, Khalil M, Therapidis P, Assmus B, Moritz A, Beiras-Fernandez A, Stock UA. Suspected involvement of EPTFE membrane in sterile intrathoracic abscess and pericardial empyema in a multi-allergic LVAD recipient: a case report. J Cardiothorac Surg 2015; 10:99. [PMID: 26183430 PMCID: PMC4504348 DOI: 10.1186/s13019-015-0305-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 06/29/2015] [Indexed: 11/10/2022] Open
Abstract
Device-related infections in recipients of left ventricular assist devices (LVAD) have been recognized as a major source of morbidity and mortality. They require a high level of diagnostic effort as part of the overall burden resulting from infectious complications in LVAD recipients. We present a multi-allergic patient who was treated for persistent sterile intrathoracic abscess formation and pericardial empyema following minimally invasive LVAD implantation including use of a sheet of e-polytetrafluoroethylene (ePTFE) membrane to restore pericardial integrity. Sterile abscess formation and pericardial empyema recurred after surgical removal until the ePTFE membrane was removed, suggesting that in disposed patients, ePTFE may be related to sterile abscess formation or sterile empyema.
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Affiliation(s)
- A Kornberger
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - V Walter
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - M Khalil
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - P Therapidis
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - B Assmus
- Department of Cardiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - A Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - A Beiras-Fernandez
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - U A Stock
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
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Affiliation(s)
- Birgit Assmus
- From the Division of Cardiology, Department of Medicine III (B.A., A.M.Z.), and Institute for Cardiovascular Regeneration, Center of Molecular Medicine (S.D.), Goethe University Frankfurt, Frankfurt, Germany
| | - Stefanie Dimmeler
- From the Division of Cardiology, Department of Medicine III (B.A., A.M.Z.), and Institute for Cardiovascular Regeneration, Center of Molecular Medicine (S.D.), Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas M Zeiher
- From the Division of Cardiology, Department of Medicine III (B.A., A.M.Z.), and Institute for Cardiovascular Regeneration, Center of Molecular Medicine (S.D.), Goethe University Frankfurt, Frankfurt, Germany
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Gyöngyösi M, Wojakowski W, Lemarchand P, Lunde K, Tendera M, Bartunek J, Marban E, Assmus B, Henry TD, Traverse JH, Moyé LA, Sürder D, Corti R, Huikuri H, Miettinen J, Wöhrle J, Obradovic S, Roncalli J, Malliaras K, Pokushalov E, Romanov A, Kastrup J, Bergmann MW, Atsma DE, Diederichsen A, Edes I, Benedek I, Benedek T, Pejkov H, Nyolczas N, Pavo N, Bergler-Klein J, Pavo IJ, Sylven C, Berti S, Navarese EP, Maurer G. Meta-Analysis of Cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data. Circ Res 2015; 116:1346-60. [PMID: 25700037 DOI: 10.1161/circresaha.116.304346] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022]
Abstract
RATIONALE The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. OBJECTIVE We analyzed the safety and efficacy of intracoronary cell therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). METHODS AND RESULTS The primary end point was freedom from combined major adverse cardiac and cerebrovascular events (including all-cause death, AMI recurrance, stroke, and target vessel revascularization). The secondary end point was freedom from hard clinical end points (death, AMI recurrence, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions. Secondary efficacy end points included changes in end-diastolic volume, end-systolic volume, and ejection fraction, analyzed with random-effects meta-analyses and ANCOVA. We reported weighted mean differences between cell therapy and control groups. No effect of cell therapy on major adverse cardiac and cerebrovascular events (14.0% versus 16.3%; hazard ratio, 0.86; 95% confidence interval, 0.63-1.18) or death (1.4% versus 2.1%) or death/AMI recurrence/stroke (2.9% versus 4.7%) was identified in comparison with controls. No changes in ejection fraction (mean difference: 0.96%; 95% confidence interval, -0.2 to 2.1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. CONCLUSIONS This meta-analysis of individual patient data from randomized trials in patients with recent AMI revealed that intracoronary cell therapy provided no benefit, in terms of clinical events or changes in left ventricular function. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01098591.
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Assmus B, Leistner DM, Schächinger V, Erbs S, Elsässer A, Haberbosch W, Hambrecht R, Sedding D, Yu J, Corti R, Mathey DG, Barth C, Mayer-Wehrstein C, Burck I, Sueselbeck T, Dill T, Hamm CW, Tonn T, Dimmeler S, Zeiher AM. Long-term clinical outcome after intracoronary application of bone marrow-derived mononuclear cells for acute myocardial infarction: migratory capacity of administered cells determines event-free survival. Eur Heart J 2014; 35:1275-83. [PMID: 24569031 DOI: 10.1093/eurheartj/ehu062] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the REPAIR-AMI trial, intracoronary infusion of bone marrow-derived cells (BMCs) was associated with a significantly greater recovery of contractile function in patients with acute myocardial infarction (AMI) at 4-month follow-up than placebo infusion. The current analysis investigates clinical outcome and predictors of event-free survival at 5 years. METHODS AND RESULTS In the multicentre, placebo-controlled, double-blind REPAIR-AMI trial, 204 patients received intracoronary infusion of BMCs (n = 101) or placebo (n = 103) into the infarct vessel 3-7 days following successful percutaneous coronary intervention. Fifteen patients died in the placebo group compared with seven patients in the BMC group (P = 0.08). Nine placebo-treated patients and five BMC-treated patients required rehospitalization for chronic heart failure (P = 0.23). The combined endpoint cardiac/cardiovascular/unknown death or rehospitalisation for heart failure was more frequent in the placebo compared with the BMC group (18 vs. 10 events; P = 0.10). Univariate predictors of adverse outcomes were age, the CADILLAC risk score, aldosterone antagonist and diuretic treatment, changes in left ventricular ejection fraction, left ventricular end-systolic volume, and N-terminal pro-Brain Natriuretic Peptide (all P < 0.01) at 4 months in the entire cohort and in the placebo group. In contrast, in the BMC group, only the basal (P = 0.02) and the stromal cell-derived factor-1-induced (P = 0.05) migratory capacity of the administered BMC were associated with improved clinical outcome. CONCLUSION In patients of the REPAIR-AMI trial, established clinical parameters are associated with adverse outcome at 5 years exclusively in the placebo group, whereas the migratory capacity of the administered BMC determines event-free survival in the BMC-treated patients. These data disclose a potency-effect relationship between cell therapy and long-term outcome in patients with AMI.
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Affiliation(s)
- Birgit Assmus
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - David M Leistner
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Volker Schächinger
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Sandra Erbs
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Albrecht Elsässer
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Werner Haberbosch
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Rainer Hambrecht
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Daniel Sedding
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Jiangtao Yu
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Roberto Corti
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Detlef G Mathey
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Christine Barth
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Charlotte Mayer-Wehrstein
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Iris Burck
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Tim Sueselbeck
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Thorsten Dill
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Christian W Hamm
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Torsten Tonn
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Stefanie Dimmeler
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Andreas M Zeiher
- Cardiology, Deptartment of Medicine III, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
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Delewi R, Hirsch A, Tijssen JG, Schächinger V, Wojakowski W, Roncalli J, Aakhus S, Erbs S, Assmus B, Tendera M, Goekmen Turan R, Corti R, Henry T, Lemarchand P, Lunde K, Cao F, Huikuri HV, Sürder D, Simari RD, Janssens S, Wollert KC, Plewka M, Grajek S, Traverse JH, Zijlstra F, Piek JJ. Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis. Eur Heart J 2013; 35:989-98. [PMID: 24026778 DOI: 10.1093/eurheartj/eht372] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. METHODS AND RESULTS We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m², 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥ 55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥ 40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. CONCLUSION Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
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Affiliation(s)
- Ronak Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Honold J, Fischer-Rasokat U, Seeger FH, Leistner D, Lotz S, Dimmeler S, Zeiher AM, Assmus B. Impact of intracoronary reinfusion of bone marrow-derived mononuclear progenitor cells on cardiopulmonary exercise capacity in patients with chronic postinfarction heart failure. Clin Res Cardiol 2013; 102:619-25. [DOI: 10.1007/s00392-013-0574-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
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Assmus B, Walter DH, Seeger FH, Leistner DM, Steiner J, Ziegler I, Lutz A, Khaled W, Klotsche J, Tonn T, Dimmeler S, Zeiher AM. Effect of shock wave-facilitated intracoronary cell therapy on LVEF in patients with chronic heart failure: the CELLWAVE randomized clinical trial. JAMA 2013; 309:1622-31. [PMID: 23592107 DOI: 10.1001/jama.2013.3527] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The modest effects of clinical studies using intracoronary administration of autologous bone marrow-derived mononuclear cells (BMCs) in patients with chronic postinfarction heart failure may be attributed to impaired homing of BMCs to the target area. Extracorporeal shock wave treatment has been experimentally shown to increase homing factors in the target tissue, resulting in enhanced retention of applied BMCs. OBJECTIVE To test the hypothesis that targeted cardiac shock wave pretreatment with subsequent application of BMCs improves recovery of left ventricular ejection fraction (LVEF) in patients with chronic heart failure. DESIGN, SETTING, AND PARTICIPANTS The CELLWAVE double-blind, randomized, placebo-controlled trial conducted among patients with chronic heart failure treated at Goethe University Frankfurt, Germany, between 2006 and 2011. INTERVENTIONS Single-blind low-dose (n = 42), high-dose (n = 40), or placebo (n = 21) shock wave pretreatment targeted to the left ventricular anterior wall. Twenty-four hours later, patients receiving shock wave pretreatment were randomized to receive double-blind intracoronary infusion of BMCs or placebo, and patients receiving placebo shock wave received intracoronary infusion of BMCs. MAIN OUTCOMES AND MEASURES Primary end point was change in LVEF from baseline to 4 months in the pooled groups shock wave + placebo infusion vs shock wave + BMCs; secondary end points included regional left ventricular function assessed by magnetic resonance imaging and clinical events. RESULTS The primary end point was significantly improved in the shock wave + BMCs group (absolute change in LVEF, 3.2% [95% CI, 2.0% to 4.4%]), compared with the shock wave + placebo infusion group (1.0% [95% CI, -0.3% to 2.2%]) (P = .02). Regional wall thickening improved significantly in the shock wave + BMCs group (3.6% [95% CI, 2.0% to 5.2%]) but not in the shock wave + placebo infusion group (0.5% [95% CI, -1.2% to 2.1%]) (P = .01). Overall occurrence of major adverse cardiac events was significantly less frequent in the shock wave + BMCs group (n = 32 events) compared with the placebo shock wave + BMCs (n = 18) and shock wave + placebo infusion (n = 61) groups (hazard ratio, 0.58 [95% CI, 0.40-0.85]; P = .02). CONCLUSIONS AND RELEVANCE Among patients with postinfarction chronic heart failure, shock wave-facilitated intracoronary administration of BMCs vs shock wave treatment alone resulted in a significant, albeit modest, improvement in LVEF at 4 months. Determining whether the increase in contractile function will translate into improved clinical outcomes requires confirmation in larger clinical end point trials. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00326989.
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Affiliation(s)
- Birgit Assmus
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Germany
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Gyongyosi M, Lemarchand P, roncalli J, Lunde K, Tendera M, Wojakowski W, Bartunek J, Wollert K, Assmus B, Zeiher A, kastrup J, Bergmann M, Atsma D, Pokushalov E, Woehrle J, Obradovic S, Sylven JC, Malliaras K, Marban E, Maurer G. SAFETY AND EFFICACY OF CARDIAC CELL THERAPY: FIRST RESULTS OF THE MESS (META–ANALYSIS OF CARDIAC STEM CELL STUDIES) DATABASE INCLUDING INDIVIDUAL PATIENT DATA OF 13 RANDOMIZED AND 3 COHORT STUDIES. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Honold J, DeRosa S, Spyridopoulos I, Fischer-Rasokat U, Seeger FH, Leistner D, Lotz S, Levy WC, Zeiher AM, Assmus B. Comparison of the Seattle heart failure model and cardiopulmonary exercise capacity for prediction of death in patients with chronic ischemic heart failure and intracoronary progenitor cell application. Clin Cardiol 2013; 36:153-9. [PMID: 23377956 DOI: 10.1002/clc.22093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/08/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite many therapeutic advances, the prognosis of patients with chronic heart failure (CHF) remains poor. Therefore, reliable identification of high-risk patients with poor prognosis is of utmost importance. Cardiopulmonary exercise testing (CPET) provides important prognostic information by peak O2 uptake (peak VO2 ), maximal oxygen pulse (O2 Pmax), O2 uptake efficiency slope (OUES), and VE/VCO2 slope (VE/VCO2 ). A different approach for prognostic assessment is the Seattle Heart Failure Model (SHFM), which is based on clinical data and calculates the estimated annual mortality. HYPOTHESIS Comparison of the prognostic value of the Seattle Heart Failure Score and cardiopulmonary excercis testing in patients with chronic heart failure. METHODS One hundred fifty-seven patients with ischemic heart failure and recent intracoronary progenitor cell application were analyzed for mortality during a follow-up of 4 years. CPET (peak VO2 , O2 Pmax, OUES, VE/VCO2 ) was performed in all patients at baseline. The SHFM score was calculated for every patient, with data obtained at the time of CPET. RESULTS During follow-up, 24 patients died (15.2%). Nonsurvivors had significantly worse initial CPET results and a higher SHFM score compared to survivors. Receiver operating characteristics curve analysis of sensitivity and specificity revealed the largest area under the curve value for the SHFM score, followed by VE/VCO2 slope. Kaplan Meier analysis using cutoff points of SHFM and VE/VCO2 slope with highest sensitivity and specificity resulted in significant discrimination of survivors and nonsurvivors. By multivariate analysis, only the SHFM score persisted as independent predictor of mortality in these patients. CONCLUSIONS These data indicate superior prognostic power of the SHFM score compared to CPET in patients with chronic ischemic heart failure.
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Affiliation(s)
- Joerg Honold
- Division of Cardiology, Department of Medicine III, Goethe University, Frankfurt, Germany
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De Rosa S, Seeger FH, Honold J, Fischer-Rasokat U, Lehmann R, Fichtlscherer S, Schächinger V, Dimmeler S, Zeiher AM, Assmus B. Procedural safety and predictors of acute outcome of intracoronary administration of progenitor cells in 775 consecutive procedures performed for acute myocardial infarction or chronic heart failure. Circ Cardiovasc Interv 2013; 6:44-51. [PMID: 23362308 DOI: 10.1161/circinterventions.112.971705] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cell-based therapies are a promising option in patients with acute myocardial infarction or chronic heart failure (CHF). However, administration of cells requires intracoronary or intracardiac instrumentation, which is potentially associated with periprocedural risks. Therefore, we analyzed periprocedural complications and 30-day outcome in 775 consecutive procedures of intracoronary administration of progenitor cells using the stop-flow technique. METHODS AND RESULTS Indications for cell administration were acute myocardial infarction (n=126) and CHF of ischemic (n=562) or nonischemic (n=87) etiology. Vessel injury was observed in a total of 9 procedures (1.2%) and could be promptly managed by additional progenitor cell injection (PCI) in all but 1 case. No procedural deaths were observed. A periprocedural increase in troponin T was observed in 3.2% of the CHF procedures, in which no concomitant PCI was performed and troponin levels were not elevated before the procedure. Independent significant predictors of troponin T increase were higher New York Heart Association (NYHA) class (NYHA I versus NYHA IV; P=0.01; NYHA I versus III; P=0.19; NYHA I versus II; P=0.55), concomitant revascularization (P<0.01), presence of elevated troponin T before the procedure (P<0.01), and peripheral occlusive disease (P=0.04). At 30 days, there were 4 deaths (0.5%), 1 stroke (0.13%), 8 acute myocardial infarctions (1%), and 5 hospitalizations for exacerbation of heart failure (0.64%). CONCLUSIONS Intracoronary infusion of progenitor cells can be performed with adequate safety in patients with acute myocardial infarction or CHF, because the safety profile was similar to what is usually expected from a coronary angiogram in the present cohort. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00962364, NCT00284713, and NCT00289822.
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Affiliation(s)
- Salvatore De Rosa
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Germany
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